Socio Demographic Questionnaire

A socio demographic questionnaire is developed for purposes of gauging the social status of a specific community or society. The formulated questions are usually subjective in nature and gauge things such as individual educational level, one’s income, assets and occupational status. The questionnaire is also used to identify the respondent’s age, gender, health status and racial group. Such questionnaires are commonly used in national household surveys for purposes of establishing the social status of an identified community. During the construction of the questionnaire, consultations are done to ensure that the survey questions are valid and acceptable in the target community.

Q1. Age ______

Q2. Gender

Male______ female______

Q3. What is your marital status?

Single______ Married______ divorced ______ separated______

Q4. What is your employment status?

Full time employed______

Part time employed______

Self-employed______

Housewife/husband______

Unemployed______

Retired______

Q5. What is your highest level of education?

Elementary school______

High school______

College______

Graduate school______

Q6. What is your degree level?

High school diploma______

Bachelor’s Degree______

Masters______

PhD______

None______

Q6. Where do you live?

In my house______

In my parents’ house______

In a co-owned/rented house______

Q7. How many other people live in the same house with you?

None______

One______

Two______

More than two______

Q8. How many other people in the house earn an income?

All______

None______

Other (specify) ______

Q9. What is your main source of financial support?

My income (paycheck or income from businesses) ______

Family support (including alimony or child support) ______

Unemployment benefits______

Workman’s compensation______

Disability benefits______

Veteran’s benefits______

Social security______

Q10. Do you have any outstanding debts? If so how much are they worth?